Sometimes the best teachers are people who nudge us ever so slightly, thereby inspiring us to reconsider certain ideas. I recently had the opportunity to speak with Dr. Laura Schmidt, Professor of Health Policy at the University of California at San Francisco. Along with her esteemed colleagues, including Dr. Robert Lustig and Dr. Allyn Taylor, Dr. Schmidt works on evidence-based policy solutions devised to curb diet-induced metabolic syndrome and its related diseases. Metabolic syndrome, which affects some 23 percent of US adults, increases one's risk of heart disease, stroke, and diabetes. With Dr. Schmidt, we discussed previous alcohol- and tobacco-related public health campaigns and what they can teach us about sugar.
To be upfront, I'm someone with a healthy mistrust of government, especially regarding legislation that might prevent me from deciding for myself what I can and can't put into my own body. I'm also someone who believes strongly in education. For most of my career, I've been teaching people how to make healthy food choices and how to prepare nourishing food.
I always thought education alone could solve diet-related health crises. Given the right information, people make informed, healthy decisions, right? But what if truly effective solutions require more than just education? What if they require government intervention? My conversation with Dr. Schmidt nudged me to consider this possibility.
Various scientific bodies, including the WHO, have conducted comprehensive reviews of the published literature regarding public health policy. These committees, Dr. Schmidt informed me, have consistently concluded that education aimed towards decreasing the consumption of unhealthy products is effective only within the context of larger strategies designed to make those products less available. Schmidt explained,
"I can tell you until I'm blue in the face don't do this or that, don't smoke, don't drink sugary drinks, but when I put you into an environment that's saturated with those products, it doesn't matter what I told you."
This means education is important, but ineffective as a stand-alone strategy. "The reason [education] matters," Schmidt continued, "is because it creates momentum for policies like taxation, which actually work."
Taxing "unhealthy products" makes me somewhat uncomfortable because who decides what is and isn't healthy? Red meat and raw milk, for example, are controversial. Some people claim they're unhealthy; others say the opposite. Taxing sugar could set a dangerous precedent whereby healthy foods could wrongly be taxed as unhealthy.
Hypotheticals aside, sugar is indeed unhealthy at current consumption levels. So what can be done to reduce consumption? During the past century, we learned that prohibition (alcohol and drugs) doesn't work, whereas taxation (alcohol and tobacco) does, especially gentle, unobtrusive taxation.
Nudging Our Way To Better Health
Dr. Schmidt recommended that I read Nudge, a book about behavioral economics by Richard Thaler and Cass Sunstein. The authors contend, and Schmidt concurs, that attempts to influence behavioral change at the population level must always be gentle and gradual. "The spirit of sound public health policy," Schmidt told me, "is one in which you don't go to any extreme, you don't get hysterical, and you don't get draconian. Moderation is the most effective approach."
This is known as The Iron Law of Public Health Policy. In other words, restrict the availability of unhealthy substances and consumption will decrease. Policies that don't restrict availability—public information campaigns, government guidelines, warning labels on products—are ineffective except when combined with policies that do.
One effective solution, which has been implemented successfully with respect to alcohol, is differential taxation. Applied to sugar, differential taxation would make bottled water incredibly cheap, diet soda a little more expensive, and sport drinks and sodas much more expensive. Another taxation scheme Schmidt and her colleagues are assessing is cap-and-trade, as per climate change, but applied to sugar.
The Way Forward
According to a 2012 Gallop poll, 48 percent of Americans drink at least one soda daily and per capita sugar consumption is more than twice the recommend daily limit, which itself might be too high. Clearly something must be done, but can sugar taxation actually work? A 2013 study published in the American Journal of Preventative Medicine found that Americans mostly don't support taxation on sugar-sweetened beverages. The most popular anti-tax sentiment was that single-product taxation schemes are arbitrary because they ignore other processed foods. That's precisely why Dr. Schmidt supports the FDA's proposed labeling changes, which would require manufacturers to report "added sugars" on nutritional labels.
An "added sugars" label would set the stage for differential taxation on all processed foods—the more added sugar in a product, the higher the tax. "That would allow us to tax all junk food, which would be a very powerful incentive for producers to just lower the sugar content. That's a really smart public health policy," Dr. Schmidt observed.
Before hearing the arguments supporting sugar taxation, I was rather against the idea. Now, I'm seeing it does make sense. It worked for tobacco and alcohol, so why not sugar? Since the Surgeon General's 1964 announcement that smoking causes lung cancer, the percentage of American who smoke has dropped from 42 to 18 percent and an estimated 8 million lives have been saved.
Results won't happen overnight—lung cancer rates didn't drop significantly until the early 1990's—but the convincing work of Dr. Schmidt and her colleagues suggests that creative, long-term public health strategies inclusive of taxation can indeed curb sugar consumption, thereby decreasing metabolic syndrome prevalence.
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Christopher James Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail: Ancestral Wisdom, Breakthrough Science, and the Dawning Nutritional Renaissance